Provider Demographics
NPI:1619973906
Name:SMITH, JAMES AM (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AM
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 S HILLSIDE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3037
Mailing Address - Country:US
Mailing Address - Phone:316-686-1024
Mailing Address - Fax:316-686-2439
Practice Address - Street 1:758 S HILLSIDE ST STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3037
Practice Address - Country:US
Practice Address - Phone:316-686-1024
Practice Address - Fax:316-686-2439
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0522570207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100230500CMedicaid
KS100230500IMedicaid
KS130688OtherMEDICARE ID
KS200422930AMedicaid
KSKA1199001Medicare PIN
KSD71417Medicare UPIN
KS100230500IMedicaid
KSKA2473013Medicare PIN
KS102583Medicare ID - Type Unspecified
KSP01034484Medicare PIN